Approved Pending Regional Office Review

Approved Pending Regional Office Review For ambulatory surgical centers (ASCs) and portable x-ray suppliers (PXRS): When credentialing, you will receive an approved pending regional office review status in PECOS.   National Government [...]

Medicare Coverage for Zika Virus Testing

Medicare Coverage for Zika Virus Testing In February, 2016 the Zika virus was declared a PHE by the WHO. In the United States, the CDC considers the Zika virus disease to be a nationally notifiable condition. The Zika virus is primarily [...]

Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim

Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Table of Contents Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Prepayment and/or Post Payment Review Tier 2 Codes [...]

Surgical Pathology Billing Tips

Surgical Pathology Billing Tips CPT Codes: 88300-88399 Surgical pathology is the study of tissues removed from living patients during surgery to help diagnose a disease and determine a treatment plan. Surgical pathology involves gross and [...]

Pathology Interpretation Services

Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]

Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427

Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427 National Government Services would like to advise providers that bill CPT code 77427, Radiation treatment management, five treatments, of the proper way to report this [...]

Background/Overview

Background/Overview Effective for dates of service on and after 1/1/2020, CMS pays OTPs, through weekly bundled payments, to deliver OUD treatment services to Medicare beneficiaries. OTP is a Medicare Part B benefit that provides coverage for [...]

Coding and Billing for OTP Services

Coding and Billing for OTP Services Table of Contents Coding and Billing for OTP Services Coding for OTP Weekly Bundles New for 2024 HCPCS Code G0137 Separate Add-on Codes Frequency of Use and Billing Billing Cycles [Return [...]

Payment Rates

Payment Rates Medicare-enrolled OTPs are paid flat dollar payment rates for the codes describing the OTP bundled services (HCPCS codes G2067 through G2080, and G2215 to G2216). Payment rates are based on the OTP provider’s geographic location. [...]

Claim Submission Instructions

Claim Submission Instructions Use the instructions on the Billing/Payment section of the CMS Opioid Treatment Program (OTP) web pages. Reviewed 9/3/2024

Billing and Payment for Dual Eligible Beneficiaries

Billing and Payment for Dual Eligible Beneficiaries A person who is eligible for both Medicare and Medicaid at the same time is “dually eligible”. Medicare is the primary payer for OTP services delivered to dually eligible beneficiaries. [...]

Psychotherapy Services

Billing Cardiac Rehabilitation Session and Session Limitations

Billing Cardiac Rehabilitation Session and Session Limitations CR sessions are limited to a maximum of two one-hour sessions per day for up to 36 sessions up to 36 weeks with the option of an additional 36 sessions over an extended [...]

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Medicare Part B pays for CR and ICR programs and related items/services. Specific criteria must be met by the Medicare beneficiary, the cardiac rehabilitation program itself, the [...]

Pulmonary Rehabilitation

Pulmonary Rehabilitation Effective 1/1/2010, Medicare Part B pays for PR if specific criteria are met by the Medicare beneficiary, the PR program itself, the setting in which it is administered and the physician administering the program, as [...]

Related Content

Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR), [...]

MLN Connects® Newsletter: September 5, 2024

MLN Connects® Newsletter: September 5, 2024 News Osteogenesis Stimulators: Prior Authorization Requirements Suspended Hospice Benefit: Expanding Prepayment Review in 4 States Skilled Nursing Facility Advance Beneficiary Notice: Revised [...]